Shane Crean

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

License

0102208199 Issued in VA

Practice address

47149 Buse Rd
Patuxent River, MD 20670-1540

Phone

(301) 342-1418

NPI assigned

Feb 7, 2022

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1644192000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721001600000",
    "number": "1356095574",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "47149 BUSE RD",
            "city": "PATUXENT RIVER",
            "state": "MD",
            "postal_code": "206701540"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "47149 BUSE RD",
            "city": "PATUXENT RIVER",
            "state": "MD",
            "postal_code": "206701540",
            "telephone_number": "301-342-1418"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CREAN",
        "first_name": "SHANE",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-02-07",
        "last_updated": "2024-07-15",
        "certification_date": "2024-07-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "171000000X",
            "taxonomy_group": "",
            "desc": "Military Health Care Provider",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "171000000X",
            "taxonomy_group": "",
            "desc": "Military Health Care Provider",
            "state": "VA",
            "license": "0102208199",
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "VA",
            "license": "0102208199",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Moises Calero, PA-C
• John Christie, M.D.
• Shawn Clausen, M.D.
• Deanna Cole, PSY.D., M.B.A.
• Traci Helene Cooksey, RPH
• Joyce K. Daftarian
• Cordon Daley, LCSW-C
• Elizabeth Ann Davenport
• Alisha Deschenes, PA-C
• Bryan Dooley, MD

• General Practice Physician in Patuxent River, MD
• Providers in Patuxent River, MD by specialty
• General Practice Physician in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 15, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.